Inside Health

Looking at Dutch and Swiss Health Systems

By GARDINER HARRIS

Published: October 30, 2007

The Swiss and Dutch health care systems are suddenly all the rage. They have features similar to proposals by at least two presidential hopefuls, and next month the United States' top health official will visit Switzerland and the Netherlands to kick the tires.

Health and Human Services Secretary Michael O. Leavitt will visit Switzerland on Nov. 7 and then fly to The Hague for two days. His schedule is filled with meetings with ministers and technocrats, hospital officials and insurance executives and patients and their advocates.

In Switzerland and the Netherlands, all people have to obtain health insurance or pay a penalty. Employers are exempt from the mandates, and private insurers and hospitals provide care.

''We have been hearing a lot of people in the health policy community talk about how those two countries had been doing new things in health access, and the secretary wanted to get a closer look at what they're doing,'' a department official said.

The trip is not a sign, however, that the Bush administration is considering major health initiatives, officials said.

''We don't have anything cooking that we haven't announced,'' the department official said. ''We would not endorse a system like the Netherlands or Switzerland's. But if there's something we could learn about their system, we should learn about it.''

Other experts, however, are endorsing the two countries' health systems.

The proposals of Senator Hillary Rodham Clinton and John Edwards borrow heavily from changes in the two countries. Mitt Romney's changes when he was governor of Massachusetts were in part modeled on those in Switzerland. Mr. Romney has not endorsed this approach as a candidate seeking the Republican presidential nomination.

The Healthy Americans Act, introduced by Senators Ron Wyden, Democrat of Oregon, and Robert F. Bennett, Republican of Utah, would largely adopt the Dutch reforms.

Mr. Wyden said Mr. Leavitt's trip was part of growing Republican support for proposals for universal health care through individual mandates and private providers.

A spokeswoman for America's Health Insurance Plans, Susan Pisano, said she was struck by Mr. Leavitt's timing. On Wednesday, Ms. Pisano's trade group will be the host of a luncheon at which Dutch and Swiss insurance executives will discuss the changes in Europe.

The event is meant to dispel the myth that every nation that provides universal health care does so through government-run systems.

''The only models we seem to focus on here are those in Canada and Great Britain, which both have government-run systems,'' Ms. Pisano said. ''We thought it made sense to look at two countries that have universal coverage but rely on the private sector to get there.''

W. David Helms, president of AcademyHealth, a health policy research organization here, said he met top Dutch health officials for several days this month in the Netherlands.

The Netherlands is a particularly good model for the United States, Mr. Helms said, because it has solved two basic problems: moving from an employer-based system to one in which individuals buy their own insurance and subsidizing care for the poor.

''I think the Netherlands is hot right now because a number of people are realizing that we need to go to an individual-based system instead of an employer-based one,'' he said.

Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said interest in the Swiss and Dutch models had soared among policy experts because of a growing consensus that the United States would never adopt a single-payer system.

Professor Blendon said that the Massachusetts plan and Gov. Arnold Schwarzenegger's proposal for California demonstrated that such changes were politically feasible, and that the Netherlands and Switzerland showed that they could work.

PHOTO: Health and Human Services Secretary Michael O. Leavitt will see health systems in the Netherlands and Switzerland. (PHOTOGRAPH BY LAWRENCE JACKSON/ASSOCIATED PRESS)